psychiatry

Question 1

1. tantrums
2. temporary drastic change in personality, memory, consciousness to avoid emotional distress
3. mother yells at child bc her husband yelled at her
4. partially remaining at a more childish level of development
5. modeling behavir after another person who is more powerful
6. separating feelings from ideas and events

Answer 1

1. acting out
2. dissociation
3. displacement
4. fixation
5. identification
6. isolation (of affect)

Question 2

1. attributing an unacceptable impulse to an external source (man who wants another woman thinks his wife is cheating on him)
2. A PT with libidinous thoughts enters a monastery (replacing at warded-off idea or feeling by an unconsciously derived emphasis on its opp)
3. bedwetting in previously potty-trained child
4. involuntary witholding of an idea or feeling from conscious awareness
5. all good or all bad
6. intentional witholding of an idea or feeling from conscious awareness

Answer 2

1. projection
2. reaction formation
3. regression
4. repression
5. splitting
6. suppression

Question 3

1. schizophrenia
2. manic episode

Answer 3

1. 2 or more of the following for > 6 mo: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
   
   • brief psychotic disorder: < 1 mo
   • schizophreniform disorders: 1-6 mo
   • schizoaffective disorder: 2 weeks of stable mood with psychotic sx + major depressive, manic episode
2. 3 of following for 1 week: distractibility, irresponsibility, grandiosity, flight of ideas, pyschomotor Agitations, less need for Sleep, Talkativeness​

Question 4

1. major depressive disorder
2. atypical depression
3. pathologic grief

Answer 4

1. 5 of 9 for 2+ weeks: Sleep disturbance, anhedonia, guilt, depressed mood, Concentration probs, App/weight changes, psychomotor retardation or agitation
   
   • increased REM sleep
   • dysthymia: milder depression lasting at least 2 yrs
2. mood reactivity, hypersomnia, weight gain, leaden paralysis, interpersonal rejection sensitivity
   
   • tx with MAOI
3. prolonged gried lasting >6-12 mo

Question 5

1. panic disorder
2. generalized anxiety disorder
3. OCD
4. PTSD
5. acute stress disorder

Answer 5

1. panic attack followed by 1+ of the following for 1 mo or more: persistent concerns of add attacks, worrying about consequences of attack, behavioral change related to attack
2. uncontrollable anxiety for at least 6 mo
3. ​​recurring intrusive thoughts or obsessios that can be relieved in part by compulsions
   
   • associated with Tourrette’s
   • tx with SSRI or clomipramine
4. persistent re-experiencing of traumatic events that lasts > 1 mo
   
   • ​acute stress disorder if < 1 mo

Question 6

1. somatic symptom disorder
2. conversion disorder
3. hypochondriasis
4. factitious disorders

Answer 6

1. variety of complaints in 1 or more organi system last months to years (physical sx w/ no identifiable cause – unconscious drives)
2. sudden loss of sensory/motor function following acute stressor; la bell indifference (indifferent towards symptoms)
3. preoccupation/fear of having serious illness despite med eval and reassurance
4. PT consciously creates physical or mental symptoms for primary gain (Munchausen)

Question 7

Personality disorders

1. Cluster A
2. Cluster B
3. Cluster C

Answer 7

1. Wierd (but no psychosis)
   
   • paranoid
   • schizoid: social withdrawal, content with social isolation (vs avoidant)
   • schizotypal: eccentric appearance, odd beliefs or magical thinking
2. Wild
   
   • antisocial: violation of rights for others (sociopath); < 18 y/o = conduct disorder
   • borderline: splitting, impulsivemenss, self-mutilation
   • histrionic: excessive emotionality + excitability, attention seeking, sexually provacative
   • narcissistic
3. Worried
   
   • Avoidant: hypersensitive to rejection and social timidity but desires relationships with others (vs schizoid)
   • Obsessive compulsive: behavior consistent w/ one’s own beliefs (vs OCD)
   • dependent: submissiving and clinging

Question 8

Intoxication and Withdrawal

1. Opioids
2. barbs
3. benzos

Answer 8

1. morphine, fentanyl, codiene, dextromethorphane, loperamide, meperidine, diphenoxylate
   
   • intox: resp depression, pinptpuptils, constipation – tx with Naltrexone (opioid antag) or addiction with partial agonists (naloxone and methadone)
   • withdrawal: sweating, piloerection, dilated pupils, NVD, rhinnorhea, yawning
2. intox = resp depression (symptomatic tx); withdrawal = delirium, cardiovascular collapse
3. intox = minor resp depression (tx with flumazenil); withdrawal = seizures

Question 9

FGA antipsychotics

Answer 9

• high potency: Trifluorazepine, Fluphenazine, Haloperidol (Try to Fly High) – EPS symptoms
• low potency: Chlorpromazine, Thoprodazome – anticholinergic, antihistamine and alpha1 blockade SE –> tx with cholinergics
• Chlorpromazine: corneal deposits
• Thiordizine: reTinal deposits
• block D2 receptors –> can have hyperprolactinemia –> galactorrhea and hypogonadism
• 4 hrs: muscle spasm/torticollis, oculogyric crisis
• 4 days: akathesia (restlessness)
• 4 weeks: bradykinesia (parkinsonism)
• 4 mo: tardive dyskinesia (chewing, grimacing)
• NMS: rigidity, myoglobinuria, hyperprexia (tx w/ Dantrolene)

Question 10

atypical antipsychotics

Answer 10

• Olanzapine: obesity
• Risperidone: galactorrhea, gynecomastia, infertility
• Ziprasidone: prolong QT interval
• Clozapine: agranulocytosis and seizures
• less EPS and anticholinergic SEs
• varied effects on 5HT2, DA, a1 and H1 receptors

Question 11

1. Lithium
2. Buspirone
3. Buproprion

Answer 11

1. mood stabilizer for bipolar and SIADH
   
   • hypothyroidism, nephrogenic diabetes insipidus, tremor/ataxia/delirium, toxicity with thiazides
2. stimulates 5HT1a receptors
   
   • tx generalized anxiety disorder
   • takes 1-2 weeks to take effect
3. atypical antidepressant and smoking cessation
   
   1. stimulant effects (seizure in bulimic PTs)

Question 12

1. SSRIs
2. SNRIs
3. TCAs

Answer 12

1. fluoxetine, paroxetine, sertaline, citalopram
   
   • sex dysfuncion, 5HT syndrome with MAOI, TCA, SNRI
2. Venlafaxine, duloxetine
   
   • inhibit 5HT and NE – increase BP
3. amitriptyline, nortriptyline, desipramine, clomipramine, amoxapine
   
   • Tri-C’s: convulsions, coma, cardiotoxicity + anticholinergic and postural hypotension
   • tx OD with NaHCO3 for cardiotoxicity

Question 13

1. MOAI
2. Mirtazapine
3. Trazodone

Answer 13

1. Tranylcypromine, Phenelzine: non-selective – increase levels of amine NTMs by blocking mito degradation in presynaptic nerve terminal
   
   • tx atypical depression
   • hypertensive crisis with tyramine
2. alpha2 antag –> increase release of NE and 5HT
   
   • use for depressed PTs who can’t sleep, eat or put on weight
3. blocks 5HT and a1 receptors
   
   • tx: insomnia
   • priapism (traza-bone) + highly sedating

Question 14

short and long-acting benzos

Answer 14

• short: triazolam, alprazolam (Xanax), midazolam (colonoscopy)
• long: diazepam, flurazepam, chlordiazepoxide
• intermed = lorazepam